Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan.
Eur Urol Focus. 2021 Mar;7(2):366-372. doi: 10.1016/j.euf.2020.01.006. Epub 2020 Jan 25.
Intermediate-risk non-muscle-invasive bladder cancer (NMIBC) involves heterogeneous patients, resulting in uncertainty regarding its prognosis and the indication of adjuvant therapy. Previous studies suggested a correlation between tumor location, especially bladder neck involvement (BNI), and patient prognosis of NMIBC.
We investigated the role of BNI in risk substratification of intermediate-risk NMIBC patients.
DESIGN, SETTING, AND PARTICIPANTS: This single-institutional study included 436 primary or recurrent intermediate-risk NMIBC patients based on risk stratification in the European Association of Urology guidelines.
All patients underwent transurethral resection of the bladder tumor.
The primary and secondary endpoints were progression and recurrence, respectively. The associations of BNI with the endpoints were examined using the Kaplan-Meier method and the Cox proportional hazards model.
Overall, 205 (47%) patients had multiple tumors and 276 (63%) underwent intravesical therapy. BNI was observed in 53 (12%) patients. During the median follow-up of 42 mo, 12 (3%) and 211 (48%) patients experienced progression and recurrence, respectively. Multivariate analysis showed that BNI was an independent predictor for both progression (hazard ratio 10.98, p < 0.001) and recurrence (hazard ratio 2.12, p < 0.001). The progression rate was significantly higher in patients with BNI compared with those without BNI (13% vs 1% at 3 yr and 20% vs 1% at 6 yr; p < 0.001). Analogous findings were observed for recurrence. The progression rate was more remarkably stratified by BNI in 103 recurrent cases (17% vs 3% at 3 yr and 34% vs 3% at 6 yr in patients with vs without BNI; p < 0.001). A limitation of this study was its retrospective nature.
BNI substratified intermediate-risk NMIBC patients well regarding their risks of progression and recurrence, which could help determine follow-up and therapeutic strategies for these patients.
The associations of bladder neck involvement with progression and recurrence were evaluated in patients with intermediate-risk non-muscle-invasive bladder cancer. We found that bladder neck involvement was a good factor for substratifying patients based on their risks of progression and recurrence. Bladder neck involvement can be useful in determining follow-up and therapeutic strategies for intermediate-risk non-muscle-invasive bladder cancer.
中危非肌肉浸润性膀胱癌（NMIBC）涉及异质性患者，导致其预后和辅助治疗指征不确定。先前的研究表明肿瘤位置，特别是膀胱颈部受累（BNI）与 NMIBC 患者的预后相关。
我们研究了 BNI 在中危 NMIBC 患者风险分层中的作用。
设计、地点和参与者：本单中心研究纳入了 436 名根据欧洲泌尿外科学会指南进行风险分层的原发性或复发性中危 NMIBC 患者。
所有患者均接受经尿道膀胱肿瘤切除术。
主要和次要终点分别为进展和复发。使用 Kaplan-Meier 方法和 Cox 比例风险模型检查 BNI 与终点的关系。
总体而言，205 名（47%）患者有多个肿瘤，276 名（63%）接受了膀胱内治疗。53 名（12%）患者存在 BNI。在中位随访 42 个月期间，分别有 12 名（3%）和 211 名（48%）患者出现进展和复发。多变量分析显示，BNI 是进展（风险比 10.98，p < 0.001）和复发（风险比 2.12，p < 0.001）的独立预测因素。与无 BNI 的患者相比，有 BNI 的患者进展率显著更高（3 年时分别为 13%和 1%，6 年时分别为 20%和 1%；p < 0.001）。在 103 例复发性病例中也观察到了类似的发现。在复发患者中，BNI 更显著地分层了进展风险（有 BNI 的患者在 3 年时的进展率为 17%，无 BNI 的患者为 3%，在 6 年时的进展率为 34%，无 BNI 的患者为 3%；p < 0.001）。本研究的一个局限性是其回顾性。
BNI 很好地分层了中危 NMIBC 患者的进展和复发风险，这有助于确定这些患者的随访和治疗策略。
评估了膀胱颈部受累与中危非肌肉浸润性膀胱癌患者进展和复发的关系。我们发现，膀胱颈部受累是基于进展和复发风险分层患者的一个良好因素。膀胱颈部受累可用于确定中危非肌肉浸润性膀胱癌的随访和治疗策略。
